Healthcare Provider Details

I. General information

NPI: 1801992557
Provider Name (Legal Business Name): ASCENSION MEDICAL GROUP MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13935 PLUMBROOK RD
STERLING HEIGHTS MI
48312-1727
US

IV. Provider business mailing address

PO BOX 14129
BELFAST ME
04915-4032
US

V. Phone/Fax

Practice location:
  • Phone: 586-939-9900
  • Fax: 586-939-8246
Mailing address:
  • Phone: 248-680-8000
  • Fax: 248-292-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002120
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number5901002120
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002120
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number5901002120
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number5901002120
License Number StateMI

VIII. Authorized Official

Name: RACHEL R PERRY
Title or Position: MANAGER
Credential:
Phone: 248-221-1918